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Twice-weekly fluconazole prophylaxis in premature infants: association with cholestasis.

AbstractBACKGROUND:
Fluconazole prophylaxis is effective in preventing invasive candidiasis in extremely low-birthweight (ELBW) infants. The authors previously reported an increased incidence of cholestasis with fluconazole prophylaxis in ELBW infants, which led to fluconazole prophylaxis being changed to a less frequent dosing (LFD) schedule of twice a week at their institution. The purpose of the present study was therefore to evaluate the effectiveness and safety of LFD fluconazole prophylaxis in preventing invasive candidiasis in ELBW infants.
METHODS:
ELBW infants who received the LFD regimen of fluconazole (twice a week for up to 6 weeks) were compared with infants who received the frequent dosing (FD) schedule (every 72 h for first 2 weeks, every 48 h for next 2 weeks and every 24 h for the final 2 weeks). The two groups were compared for baseline demographics, risk factors for candidiasis, the rate of invasive fungal infection and the incidence and severity of cholestasis.
RESULTS:
There was no significant difference in the incidence of invasive candidiasis in infants who received the LFD (2/104, 2%) compared to FD (0/140, 0%; P= 0.4) fluconazole prophylaxis. The severity of cholestasis was lower and a trend towards decreased incidence of cholestasis was observed on the LFD schedule.
CONCLUSION:
The LFD regimen of fluconazole prophylaxis is effective in preventing invasive fungal infection in ELBW infants. The severity of cholestasis was decreased with the LFD schedule.
AuthorsVishwanath Bhat, Milliecor Fojas, Judy G Saslow, Sahil Shah, Sulaiman Sannoh, Barbara Amendolia, Kee Pyon, Nicole Kemble, Gary Stahl, Zubair H Aghai
JournalPediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 53 Issue 4 Pg. 475-9 (Aug 2011) ISSN: 1442-200X [Electronic] Australia
PMID21040197 (Publication Type: Comparative Study, Controlled Clinical Trial, Journal Article)
Copyright© 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.
Chemical References
  • Antifungal Agents
  • Fluconazole
Topics
  • Antifungal Agents (administration & dosage, adverse effects, therapeutic use)
  • Candidiasis, Invasive (epidemiology, prevention & control)
  • Cholestasis (chemically induced, epidemiology)
  • Drug Administration Schedule
  • Female
  • Fluconazole (administration & dosage, adverse effects, therapeutic use)
  • Humans
  • Incidence
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases (prevention & control)
  • Linear Models
  • Male
  • Retrospective Studies
  • Risk Factors

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